微创单侧椎板入路双侧减压治疗老年腰椎管狭窄症的疗效

目的探讨微创单侧椎板入路双侧减压治疗老年腰椎管狭窄症的临床效果。方法回顾性分析采用单侧椎板入路双侧椎管减压治疗的23例老年腰椎管狭窄症患者的临床资料,分析该术式临床效果。男7例,女16例;年龄65~79岁,平均73.5岁。术后随访1年以上。采用JOA评分方法对患者术前术后症状进行评分。结果 JOA评分术后症状均有不同程度改善(P0.01)。结论微创单侧椎板入路双侧减压可以作为治疗老年腰椎管狭窄症的有效方法之一。     

老年退行性腰椎管狭窄症82例手术治疗体会

目的探讨手术治疗老年退行性腰椎管狭窄症（DLSS）的临床效果。方法对同期收治的82例DLSS患者于针对性治疗并发内科疾病后行手术治疗,根据病情分别选择椎板开窗减压、髓核摘除、黄韧带切除、侧隐窝及神经根管扩大术,半椎板切除减压并侧引窝扩大术、全椎板切除减压术等。观察手术一般情况并随访判定疗效。结果手术时间平均1．5h,出血量平均240ml,术中无1例因出现意外而终止手术,住院时间平均18d;67例获平均随访14个月,疗效为优25例、良31例、无变化8例、差3例,优良率84％。结论在加强围手术期处理及选择合适手术方案前提下,手术治疗老年DLSS临床效果确切、安全性较高。     

全椎板切除减压椎弓根固定后外侧植骨融合术治疗腰椎管狭窄症

目的探讨后路全椎板切除减压椎弓根固定后外侧植骨融合术治疗腰椎管狭窄症的临床效果。方法2002年1月喇8年6月我院收治的腰椎管狭窄症患者55例,手术方法为后路全椎板切除减压术＋椎弓根螺钉固定术＋后外侧植骨术。结果所有病例均得到随访,平均36个月（6-72个月）,47例优或良,6例可,2例差。优良率85．5％。结论后路全椎板切除减压椎弓根固定后外侧植骨融合术治疗腰椎管狭窄症临床效果肯定。     

65岁以上老年人腰椎管狭窄症手术治疗的临床分析

目的 探讨老年人腰椎管狭窄症手术治疗的可靠性、手术方法及手术后效果。方法 回顾性分析1990年1月至2005年6月我院收治的65岁以上老年腰椎管狭窄症患者304例，其病程3~360个月，平均139．2个月，手术方法主要为单纯全椎板切除减压术、多节段椎板开窗减压术、全椎板及侧隐窝神经根管减压＋椎弓根螺钉固定术＋椎体间或（和）横突间植骨术。结果 术后264例恢复良好或优，优良率86．8％；34例感觉与术前比，变化不大；有6例较术前加重；无术中死亡患者。结论 老年患者多病程长、术前各种并存症多，掌握手术适应证应慎重，术前详细检查并积极地处理并存症、多科共同协作是手术成功的关键。手术应在充分的减压基础上尽量减少损伤，最短时间完成手术，根据实际合理的内固定促进植骨融合。术后积极的功能锻炼、早期的下床活动是保证手术效果、减少术后并发症的关键。     

多节段退变性腰椎管狭窄症手术治疗的疗效观察

目的探讨多节段退变性腰椎管狭窄症手术治疗疗效。方法自2005年3月～2009年10月,采用广泛椎板减压椎弓根螺钉内固定、椎间融合和后外侧融合或椎管钛网成形治疗多节段腰椎管狭窄症患者46例。术后平均随访3.7 a,应用JOA评分(29分法)对手术前后临床疗效进行主客观评价。结果术后患者JOA评分较术前有显著提高(P均<0.01)。术后半年优良率86.9%。结论采用广泛椎板减压椎弓根螺钉内固定、椎间融合和后外侧融合或椎管钛网成形治疗多节段退变性腰椎管狭窄症,可取得满意和持久的临床疗效。     

经后路减压椎弓根钉棒内固定椎间融合治疗高龄腰椎退行性疾病的疗效

<正>本文高龄患者主要特指80岁及以上患者,腰椎退行性疾病主要包括腰椎管狭窄症和腰椎滑脱。高龄患者多数症状重,病程长,保守治疗效果不佳,同时合并多种基础疾病,如骨质疏松、围术期心肺功能也面临巨大挑战〔1〕,如何成功地开展手术治疗以显著提高生活质量,成为治疗的关键。本院对高龄腰椎退行性疾病患者采用经后路减压椎弓根钉棒内固定椎间融合治疗。1材料与方法1.1一般资料2010年8月至2013年6月收治27例高龄腰     

椎板及后韧带复合结构瓣回植治疗退行性腰椎管狭窄症的疗效

<正>退行性腰椎管狭窄症(DLSS)临床表现以腰腿疼痛、间歇性跛行为主〔1,2〕。目前对DLSS的手术治疗方法主要是椎管减压术,但如果手术切除减压范围太大可能会导致脊柱不稳,严重者可引起腰椎滑脱〔3,4〕。本研究观察保留椎板及后韧带复合结构瓣回植治疗DLSS的疗效。1临床资料1.1一般资料我科DLSS患者42例,男27例,女15例;年龄55~79(平均61.2)岁。纳入标准:1有典型的腰腿疼痛、间     

椎板减压、棘突重建椎板术治疗椎管狭窄

腰椎管狭窄症和特殊类型的腰椎间盘突出症常用手术方法是全椎板切除,有侧椎管狭窄者加做小关节突部分切除术。此法虽减压彻底,但术后可产生医源性腰椎不稳,且硬脊膜后面失去半环形骨性覆盖,增厚的瘢痕可对硬脊膜形成新的压迫。为此,我们设计了新的手术方法,采用椎板减压,棘突重建椎板术治疗腰椎管狭窄症8例,收效满意。 1.临床资料:男5例,女3例,年龄41～65岁。退变性椎管狭窄症2例,椎间盘突出合并椎管狭窄6例。其中L_(3、4),L_(4、5),     

老年人腰椎管狭窄症的临床特点及手术治疗

目的探讨老年人退行性腰椎管狭窄症的临床特点和手术效果。方法回顾性分析42例老年人退行性腰椎管狭窄症的临床资料。结果老年人退行性腰椎管狭窄的特征为腰椎多节段退变,起病缓慢,间歇性跛行是最长伴有的症状,直腿抬高试验阳性率低,中央椎管和神经根管都有不同程度的狭窄,突出较少的椎间盘就能压迫硬膜囊或神经根而产生疼痛,所有患者的手术均安全完成。平均随访2.1年,根据JOA评分系统,将手术前后JOA评分比较,差异有统计学意义(P0.05)。结论老年人退行性腰椎管狭窄症患者合并内科疾病多,较长的病程,症状多体征少,多节段退变,积极治疗内科并发症,根据症状、体征、影像学,给予责任节段充分减压及固定融合责任节段,能获得较好手术疗效。     

老年腰椎间盘突出症或腰椎管狭窄症再手术的探讨

目的分析老年腰椎间盘突出症或腰椎管狭窄症的初次手术失败原因,提出再手术的方法及注意事项。方法对24例腰间盘突出症或腰椎管狭窄症第1次手术失败,导致术后症状无明显好转或加重而再手术(24例患者全部行彻底椎板减压,钉棒的内固定植骨融合)资料进行回顾性分析。结果初次手术失败原因主要为椎间盘摘除术后或腰椎管狭窄减压术后未做恢复脊柱高度及脊柱稳定手术,造成脊柱不稳,椎管或神经根管进一步狭窄,导致神经根受压所致的根性痛。再次手术后24例病人经1年以上随访,术后效果良好,优良率91.67%。结论钉棒系统加Cage联合应用是治疗腰椎间盘突出或腰椎管狭窄症术后复发的有效方法。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.